Paying women to donate oocytes has sparked much controversy. Interestingly, a duality of practice has evolved. In many parts of the world compensation is prohibited, while in some countries, particularly the United States, donating gametes is handsomely rewarded. It seems naive to presume a consensus will be reached regarding the correct approach. Furthermore, the United States is highly unlikely to curtail or regulate payments by law. Thus, supply and demand will inevitably continue to dictate policy, and the price of oocyte donation will escalate along with donor fees. There exists an inherent moral ambiguity in a practice of medicine that simultaneously places young women at risk of infertility while treating the childlessness of other women. Which need is paramount? Do benefits to one group far outweigh the risks posed to the other? These issues fascinate medical ethicists but torment practitioners who choose to provide services to women needing donor eggs.